Document Detail


Doxycycline improves filarial lymphedema independent of active filarial infection: a randomized controlled trial.
MedLine Citation:
PMID:  22610930     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this study was to determine whether improvement of filarial lymphedema (LE) by doxycycline is restricted to patients with ongoing infection (positive for circulating filarial antigen [CFA]), or whether the majority of CFA-negative patients with LE would also show a reduction in LE severity.
METHODS: One hundred sixty-two Ghanaian participants with LE stage 1-5 (Dreyer) were randomized blockwise into 2 groups (CFA positive or negative) and allocated to 3 treatment arms of 6 weeks: (1) amoxicillin (1000 mg/d), (2) doxycycline (200 mg/d), or (3) placebo matching doxycycline. All groups received standard hygiene morbidity management. The primary outcome was reduction of LE stages. Secondary outcomes included frequency of acute attacks and ultrasonographic assessment of skin thickness at the ankles. Parameters were assessed before treatment and after 3, 12, and 24 months.
RESULTS: Doxycycline-treated patients with LE stage 2-3 showed significant reductions in LE severity after 12 and 24 months, regardless of CFA status. Improvement was observed in 43.9% of doxycycline-treated patients, compared with only 3.2% and 5.6% in the amoxicillin and placebo arms, respectively. Skin thickness was correlated with LE stage improvement. Both doxycycline and amoxicillin were able to reduce acute dermatolymphangioadenitis attacks.
CONCLUSIONS: Doxycycline treatment improves mild to moderate LE independent of ongoing infection. This finding expands the benefits of doxycycline to the entire population of patients suffering from LE. Patients with LE stage 1-3 should benefit from a 6-week course of doxycycline every other year or yearly, which should be considered as an improved tool to manage morbidity in filarial LE. Clinical Trials Registration. ISRCTN 90861344.
Authors:
Sabine Mand; Alexander Yaw Debrah; Ute Klarmann; Linda Batsa; Yeboah Marfo-Debrekyei; Alexander Kwarteng; Sabine Specht; Aurea Belda-Domene; Rolf Fimmers; Mark Taylor; Ohene Adjei; Achim Hoerauf
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-05-18
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  55     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-07     Completed Date:  2013-07-08     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  621-30     Citation Subset:  IM    
Affiliation:
Institute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN23868518
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Amoxicillin / therapeutic use
Ankle / pathology,  ultrasonography
Doxycycline / therapeutic use*
Female
Filariasis / blood,  drug therapy*,  pathology
Filaricides / therapeutic use*
Ghana
Humans
Kaplan-Meier Estimate
Leg / pathology
Lymphedema / blood,  drug therapy*,  parasitology,  pathology
Male
Middle Aged
Skin / pathology,  ultrasonography
Statistics, Nonparametric
Vascular Endothelial Growth Factor Receptor-3 / blood
Chemical
Reg. No./Substance:
0/Filaricides; 26787-78-0/Amoxicillin; 564-25-0/Doxycycline; EC 2.7.10.1/Vascular Endothelial Growth Factor Receptor-3
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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